Wiki Need help !!! - I need to know the proper

[lopezk89]

I need to know the proper way to code a pap and annual visit and I have some codes the G0101 and the Q0091 Do I use just these or are there other codes I can use in junction with these. IT is very confusing to me and just want to be doing it correctly

 

[LindaEV]

Depends on what exactly is done and the insurance. Also, what exactly does an "annual visit" mean in your office...this can vary!

Q0091- Collection of a pap smear (ONLY)
G0101- Pelvic/Breast exam (ONLY- but must hit 7 of 11 specified bullets)

These are known as "Medicare" codes, but some commercial payers will take them as well.

For a "well woman exam" some commercial payers will want a preventative code (i.e. 99396) with a V72.3 dx.

Medicare does not pay on preventative codes, unless you are doing a "welcome to medicare exam" or an "annual wellness visit...in which you would code those AND code the Q and G codes IF THEY are done at the same time.

If you are doing a COMPLETE PHYSICAL and a pap for medicare...you can carve out
the pap and such from a preventative code (99397) and the patient has to pay the difference.

It can be confusing I agree! Does this help?

 

[lopezk89]

I am fairly new to all of this what do you mean by carve out the pap , Just don't charge the insurance but charge the patient so i will need to have them sign an ABN ? Then my next question is does medicare not cover a pap at all. Sorry I know this is stupid just need to know. By annual it a true annual all the routine check up stuff so I guess to be more specific preventative visit.